Diaphragm Diseases, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Diaphragm Diseases, Diagnosis and Treatment and Related DiseasesThe diaphragm that separates the thoracic and abdominal cavities is the main muscle involved in breathing. Similar to any organ or muscle, the diaphragm is prone to disorders and anomalies, which come in many different forms and can result from injury or illness. Diaphragm disorders can result from nerve damage, primary muscle problems, or problems with the muscle's interaction with the chest wall.
CausesCauses of diseases of the diaphragm differ, but they are normally an effect of disorders with the anatomy or the neurological system, such as:1. Congenital defects, which happen at birth and have no known cause2. Acquired defects, which occur as the result of an injury, accident or surgerya. Strokeb. Muscular disorders, such as muscular dystrophyc. Multiple sclerosisd. Thyroid disordersSymptomsUnilateral diaphragmatic paralysis or weakness rarely causes symptomatic dyspnea at rest, but may result in dyspnea on exertion or the patient's voluntary restriction of activity.
It can occasionally cause dyspnea when lying on one's backFrequently, unilateral diaphragmatic paralysis is detected incidentally on a chest X-ray obtained for other purposes. Bilateral diaphragmatic paralysis often produces dyspnea at rest, during exertion, when lying supine (need sleeping in a recliner), bending over, or when swimming in water above waist level. Sleep disorders are also frequently in these patientsRepeat occurrences of pneumonias (possibly due to basilar collapse of the lung) and repeat occurrences of respiratory failure are also possible.
Many people with diaphragmatic paralysis compensate well when at rest and are not acutely ill. Symptoms differ based on the disorder, but may be:1. Discomfort or difficulty breathing2. Pain in the chest, shoulder or abdominal area3. Hypoxemia (a lack of oxygen in the blood)4. Fewer breath soundsDiagnosisChest X-rays in diaphragm paralysis may reveal elevated hemi-diaphragms and basal sub-segmental atelectasisFluoroscopy of the diaphragm ("sniff test"): The patient sniffs vigorously during fluoroscopy;Descent of the diaphragm is the normal reaction.
Pulmonary function tests show restriction, which may be moderate to severe (30-50% forecasted total lung capacity) in bilateral diaphragmatic paralysis. The limitation becomes worse when supine, with a proven drop in vital capacity of 30 to 50% in bilateral diaphragm paralysis. Ultrasound can be very useful in evaluating diaphragmatic function. The diaphragm should thicken with inspiration, indicating the shortening of the diaphragmatic musclesTreatmentTreatment for diaphragmatic dysfunction normally comprises:1.
Watchful waiting, 2. Treating underlying causes, with mechanical ventilation if respiratory failure occurs. Supportive treatment for DiaphragmThis is diaphragmatic pacing, which is the same as a heart pacemaker but the electrodes are implanted on the diaphragm to guide respirationSurgeryThis may require removing part of the diaphragm or abnormal tissue, folding the diaphragm, or repairing the muscle.
Repair may involve the phrenic nerveMany patients with severe diaphragmatic dysfunction require ventilatory support. Medical Care:1. Any obvious contributing factors (hypo-kalemia, hypophosphatemia, high-dose steroids, neurotoxic drugs, neuromuscular blockers) should be removed.2. Nocturnal noninvasive ventilation of people is used with:An awake pCO2 of 45+ mm Hg;Nocturnal hypoxemia (SaO2 5 consecutive min); or3.
Any sleep-disordered breathing, if present, should be treated with continuous positive airway pressure (CPAP) or nocturnal noninvasive ventilationTABLE OF CONTENTIntroductionChapter 1 Diaphragm Diseases...